Gluteal Region

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Gluteal Region Important anastomosis in the
thigh
Dr. Vohra
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Gluteal Region
The bulky region of hip (the buttocks)
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Contents of the Gluteal Region
Ligaments Sacrotuberous sacrospinous Ligaments
Foramina Greater sciatic lesser sciatic
Muscles Gluteal maximus, gluteal medius, gluteal
minimus, tensor fasciae latae, piriformis,
obturator internus, superior/inferior gemelli
quadratus femoris
Vessels Superior inferior gluteal arteries
Nerve Sciatic, posterior cutaneous nerve of
thigh, superior gluteal, inferior gluteal, nerve
to quadratus femoris, nerve to obturator internus
pudendal nerve
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Ligaments of the Gluteal Region
The function of these ligaments is to stabilize
the sacrum and prevent its rotation at the
sacroiliac joint by the weight of the vertebral
column
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Foramina of the Gluteal Region

1. Greater Sciatic Foramen

• Is formed by the greater sciatic notch of the hip
  bone and the sacrotuberous and sacrospinous
  ligaments.
• Structures exit the foramen
• Piriformis
• Sciatic nerve
• Posterior cutaneous nerve of the thigh
• Superior and inferior gluteal nerves
• Nerves to the obturator internus and quadratus
  femoris
• Pudendal nerve
• Superior and inferior gluteal arteries and veins
• Internal pudendal artery and vein

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1. Lesser Sciatic Foramen

• Is formed by the lesser sciatic notch of the hip
  bone and the sacrotuberous and sacrospinous
  ligaments.
• Structures exit the foramen
• Tendon of obturator internus muscle
• Nerve to obturator internus
• Pudendal nerve
• Internal pudendal artery and vein

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Muscles of the Gluteal Region
Muscle Origin Insertion Nerve Supply Nerve Roots Action
Gluteus maximus Outer surface of ilium, sacrum, coccyx, sacrotuberous ligament Iliotibial tract and gluteal tuberosity of femur Inferior gluteal nerve L5 S1, 2 Extends and laterally rotates hip joint through iliotibial tract, it extends knee joint
Gluteus medius Outer surface of ilium Lateral surface of greater trochanter of femur Superior gluteal nerve L5 S1 Abducts thigh at hip joint tilts pelvis when walking to permit opposite leg to clear ground
Gluteus minimus Outer surface of ilium Anterior surface of greater trochanter of femur Superior gluteal nerve L5 S1 Abducts thigh at hip joint tilts pelvis when walking to permit opposite leg to clear ground
Tensor fasciae latae Iliac crest Iliotibial tract Superior gluteal nerve L4 5 Assists gluteus maximus in extending the knee joint
Piriformis Anterior surface of sacrum Upper border of greater trochanter of femur First and second sacral nerves L5 S1, 2 Lateral rotator of thigh at hip joint
Obturator internus Inner surface of obturator membrane Upper border of greater trochanter of femur Sacral plexus L5 S1 Lateral rotator of thigh at hip joint
Gemellus superior Spine of ischium Upper border of greater trochanter of femur Sacral plexus L5 S1 Lateral rotator of thigh at hip joint
Gemellus inferior Ischial tuberosity Upper border of greater trochanter of femur Sacral plexus L5 S1 Lateral rotator of thigh at hip joint
Quadratus femoris Lateral border of ischial tuberosity Quadrate tubercle of femur Sacral plexus L5 S1 Lateral rotator of thigh at hip joint
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Gluteus Maximus and Intramuscular Injections
Great thickness of gluteus maximus muscle makes
it ideal for intramuscular injections. To avoid
injury to the underlying sciatic nerve, the
injection should be given well forward on the
upper outer quadrant of the buttock.
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Nerves of the Gluteal Region
Sciatic Nerve Is a branch of the sacral plexus
(L4 and 5 S1, 2, and 3), emerges from the pelvis
through the lower part of the greater sciatic
foramen. It is the largest nerve in the body and
consists of the tibial and common peroneal nerves
bound together with fascia. The sciatic nerve
usually gives no branches in the gluteal
region. Posterior Cutaneous Nerve of the Thigh Is
a branch of the sacral plexus, enters the gluteal
region through the lower part of the greater
sciatic foramen below the piriformis
muscle. Superior Gluteal Nerve Is a branch of the
sacral plexus, leaves the pelvis through the
upper part of the greater sciatic foramen above
the piriformis.
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Inferior Gluteal Nerve Is a branch of the sacral
plexus, leaves the pelvis through the lower part
of the greater sciatic foramen below the
piriformis. Nerve to the Quadratus Femoris A
branch of the sacral plexus, leaves the pelvis
through the lower part of the greater sciatic
foramen. Ends by supplying the quadratus femoris
and the inferior gemellus. Pudendal Nerve the
Nerve to the Obturator Internus Branches of the
sacral plexus, they leave the pelvis through the
lower part of the greater sciatic foramen, below
the piriformis
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Arteries of the Gluteal Region
Superior Inferior Gluteal Artery are branches
from the internal iliac artery.
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Important anastomosis in the thigh
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The Trochanteric Anastomosis The trochanteric
anastomosis provides the main blood supply to the
head of the femur. The nutrient arteries pass
along the femoral neck beneath the capsule. The
following arteries take part in the anastomosis
the superior gluteal artery, the inferior gluteal
artery, the medial femoral circumflex artery, and
the lateral femoral circumflex artery. The
Cruciate Anastomosis The cruciate anastomosis is
situated at the level of the lesser trochanter of
the femur and, together with the trochanteric
anastomosis, provides a connection between the
internal iliac and the femoral arteries. The
following arteries take part in the anastomosis
the inferior gluteal artery, the medial femoral
circumflex artery, the lateral femoral circumflex
artery, and the first perforating artery, a
branch of the profunda artery.
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Thank you